Herbal
medicines for treatment of Irritable Bowel
Syndrome
Beijing University of Chinese Medicine, Evidence-Based Chinese Medicine Centre for Clinical Research and Evaluation, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, China, 100029. Jianping_l@hotmail.com
BACKGROUND:
Traditional herbal therapies
have been used for a long time
to treat gastrointestinal disorders
including irritable bowel syndrome,
and their effectiveness from
clinical research evidence needs
to be systematically reviewed.
OBJECTIVES:
To assess the effectiveness
and safety of herbal medicines
in patients with irritable bowel
syndrome.
SEARCH STRATEGY:
We searched the following electronic
databases till July 2004: The
Cochrane Library (CENTRAL),
MEDLINE, EMBASE, AMED, LILACS,
the Chinese Biomedical Database,
combined with hand searches
of Chinese journals and conference
proceedings till end of 2003.
No language restriction was
used.
SELECTION CRITERIA:
Randomized controlled trials
of herbal medicines compared
with no treatment, placebo,
pharmacological interventions
were included.
DATA COLLECTION AND
ANALYSIS: Data were
extracted independently by two
authors. The methodological
quality of trials was evaluated
using the components of randomization,
allocation concealment, double
blinding, and inclusion of randomized
participants.
MAIN RESULTS:
Seventy-five randomized trials,
involving 7957 participants
with irritable bowel syndrome,
met the inclusion criteria.
The methodological quality of
three double-blind, placebo-controlled
trials were high, but the quality
of remaining trials was generally
low. Seventy-one different herbal
medicines were tested in the
included trials, in which herbal
medicines were compared with
placebo or conventional pharmacologic
therapy. Herbal medicines were
also combined with conventional
therapy and compared to conventional
therapy alone. Compared with
placebo, a Standard Chinese
herbal formula, individualized
Chinese herbal medicine, STW
5 and STW 5-II, Tibetan herbal
medicine Padma Lax, traditional
Chinese formula Tongxie Yaofang,
and Ayurvedic preparation showed
significantly improvement of
global symptoms. Compared with
conventional therapy in 65 trials
testing 51 different herbal
medicines, 22 herbal medicines
demonstrated a statistically
significant benefit for symptom
improvement, and 29 herbal medicines
were not significantly different
than conventional therapy. In
nine trials that evaluated herbal
medicine combined with conventional
therapy, six tested herbal preparations
showed additional benefit from
the combination therapy compared
with conventional monotherapy.
No serious adverse events from
the herbal medicines were reported.
AUTHORS' CONCLUSIONS: Some herbal medicines
may improve the symptoms of
irritable bowel syndrome. However,
positive findings from less
rigorous trials should be interpreted
with caution due to inadequate
methodology, small sample sizes,
and lack of confirming data.
Some herbal medicines deserve
further examination in high-quality
trials.
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